This proposal is organized around the relationship between delivery system structure, use of PCOR-based evidence, and related clinical and economic outcomes. The central question guiding our proposal is whether differences in the delivery of evidence-based care processes and clinical and economic outcomes can be explained by characteristics of organizations that can be understood and modified, or whether such outcomes are 'residual' characteristics of organizations that are hard to transfer. To address this question, we envision collecting three types of data: an 'enhanced system database' that describes the health system from various perspectives, including hospitals, physicians, and other institutional providers; clinical data from a variety of data bases; and patient and family self-reports about quality of care received. These data will be used in five projects: one examining delivery system characteristics and outcomes nationally; a second focusing on four states with excellent data and diverse health needs (Colorado, Maine, Massachusetts, and Utah); a third and fourth focusing on particular populations where many concerns have been raised about lack of attention to evidence-based care: cancer and pediatrics; and a fifth examining the causes and consequences of corporate integration in dialysis and post-acute care, two industries with major health consequences but which are poorly studied. Major outputs of the project include the construction of new data sets, research papers on these various topics, and disseminating results to market participants and policy makers. Our goal is to learn which features of delivery systems influence the diffusion of evidence-based care, in order to accelerate the quality and value performance of health systems.